[Thyroid nodules. Surgical aspects]

This is a restrospective study of 176 thyroid nodules operated between 1977 and 1990, excluding bilateral goiters. 145 were benign with 111 cold and 34 hot nodules; 31 were cancers. Fine needle biopsy (FNB) is useless in hot nodules. For the cold ones, even in recent series, FNB can give false positive or negative results. This means that the answer of FNB should be closely related to the clinical and US findings. The surgical treatment of thyroid nodules must be a total lobectomy including the isthmus. The recurrent laryngeal nerve must be followed entirely. There was no permanent nerve palsy among the 122 total lobectomies. The risk of developing another controlateral nodule later is low (2/110 cases). It is very difficult to distinguish a follicular cancer from an adenoma on frozen section. For this reason, the patient should be warned that a second operation might be necessary some days later if the definitive diagnosis is a follicular cancer. For a non-invasive and non-metastatic papillary cancer, total lobectomy is sufficient. More advanced papillary and all other thyroid cancers should be treated by a total thyroidectomy.